> ## Documentation Index > Fetch the complete documentation index at: https://help.elationhealth.com/llms.txt > Use this file to discover all available pages before exploring further. # Managing Denials in Elation Billing > Overview of how to identify, work, and resolve insurance claim denials in Elation Billing ## Overview A denial is a claim that the payer adjudicated and chose not to pay (i.e. paid at \$0). A denial is different from: * **Rejection** — the claim never reached the payer for adjudication because of a front-end edit at the clearinghouse or payer. Fix the issue and resend the claim to the clearinghouse. * **Underpayment** — the claim was paid, but for less than expected. Post the payment if you agree to the decision or file an appeal using [Claim Appeals](https://help.elationhealth.com/articles/claim-appeals). * **Recoupment** — the payer takes back a previously posted payment, often via a future ERA. Use [Posting Voided, Reversed, or Updated Payments](/articles/posting-voided-reversed-or-updated-payments) to correct the payment or or file an appeal using [Claim Appeals](https://help.elationhealth.com/articles/claim-appeals). * **Contractual write-off (CO45)** — not a denial; the payer paid the contracted amount and the difference from billed is written off - this can typically be posted unless the contracted amount does not match your contract terms. Working denials promptly protects revenue, keeps A/R aging healthy, and avoids missing timely-filing limits. ## Before you begin * Have the EOB or ERA in front of you, with the **CARC** (Claim Adjustment Reason Code) and **RARC** (Remittance Advice Remark Code) for each denied line. * Know the payer's timely-filing and timely-appeal limits. ## Glossary * **CARC (Claim Adjustment Reason Code)** — explains why an adjustment was made (e.g., `CO29` timely filing, `CO50` non-covered, `PR1` deductible). * **RARC (Remittance Advice Remark Code)** — supplemental detail (e.g., `MA01` appeal rights, `N115` LCD denial). * **Group code** — prefix on a CARC indicating who is responsible: * `CO` Contractual obligation (provider write-off) * `PR` Patient responsibility * `OA` Other adjustment * `PI` Payer initiated * **Partial denial** — some lines on a claim paid, others denied. * See [Common Code Denials](/articles/common-code-denials) for a reference list of common denial codes and their typical resolution paths. ## End-to-end workflow Denials typically surface in the ERA review queue, the Claims tab, and on the A/R aging report. Identify the CARC, RARC, and group code on each affected line. For guidance on resolving specific denial codes, take a look at our [Common Code Denials](https://help.elationhealth.com/articles/common-code-denials) article. Common categories: eligibility, coding, authorization, demographics, COB, timely filing, medical necessity. Record a \$0 payment with the adjustment code(s) to capture the denial in financials and route the balance while you work on a resolution. Add a **Claim Note** and **Payment Note** with date, payer, code, action, and follow-up details. * Use a consistent Note format on every worked denial so the audit trail is searchable and reportable: ```text theme={null} [Date] [Payer ref / EOB #] - Denied CARC [code] [RARC if any]: [reason]. Action: [resubmit / corrected claim / appeal / write off / transfer to patient]. Follow-up by: [date]. ``` Take the necessary action needed for the denial. Common actions include: * Resubmit the claim after correcting issues. * Appeal the denial if no issues were identified. * Write off the balance if you missed the appeal deadline or a resolution cannot be reached. * Transfer the balance to the patient if appropriate. Confirm the claim's new status and set a follow-up date. ## Decision matrix For a side-by-side mapping of denial type → common CARCs → typical action, plus a fuller reference list of certain codes and their resolutions, see [Common Code Denials](/articles/common-code-denials). ## Step-by-step articles Use these articles for the tactical work as needed: * Find and review denied claims — see [Claim History](/articles/claim-history) and [Viewing ERAs and Auto-Posting](/articles/viewing-eras-and-auto-posting). * Post a denial (record a \$0 payment with adjustment) — see [Posting a Payment in Elation Billing](/articles/posting-a-payment-in-elation-billing). * Resubmit a corrected claim — see [Filing a Corrected Claim](/articles/filing-a-corrected-claim). * Appeal a denial — see [Claim Appeals](/articles/claim-appeals). * Write off a denied claim — settle the claim with the appropriate adjustment code; see [Posting a Payment in Elation Billing](/articles/posting-a-payment-in-elation-billing). * Recoupments and reversals — see [Posting Voided, Reversed, or Updated Payments](/articles/posting-voided-reversed-or-updated-payments). * Reporting and KPIs — see [Denials Reporting](/articles/denials-reporting). ## Special cases * Partial denial (some lines paid, some denied) — work each denied line independently. Record the paid lines normally and post a \$0 with adjustment on the denied lines. If you disagree with the denial, file an appeal using [Claim Appeals](https://help.elationhealth.com/articles/claim-appeals). * Recouped claim (offset on a future ERA) — typically handled as a reversal against the original payment. See [Posting Voided, Reversed, or Updated Payments](/articles/posting-voided-reversed-or-updated-payments). If you disagree with the recoupment, file an appeal using [Claim Appeals](https://help.elationhealth.com/articles/claim-appeals). * Patient already paid the transferred balance — the claim may now have a credit. See [Manage patient credits and overpayments](/articles/how-can-i-manage-patient-credits-and-overpayments-in-elation-billing). * Capitation denial — capitation claims are settled, not paid; see [Posting a Capitation Payment](/articles/posting-a-capitation-payment). * Front-end rejection (clearinghouse, not payer) — the claim never reached the payer for adjudication; correct the issue and resubmit. See [Claims Queue](/articles/claims-queue). * Crossover denial (Medicare to Medicaid) — confirm the crossover indicator on the original claim before resubmitting to the secondary payer directly. * Bulk denials from one payer — likely a payer system issue or contract issue. Reach out to the payer for clarification before reworking individual claims. ## Preventing denials Denials are cheaper to prevent than to work. Front-load these checks: * Verify eligibility at scheduling and check-in. * Track prior authorizations and referrals before service. * Review coding before claim submission. * Keep provider credentialing current with each payer. * Use the claim scrubber to catch front-end errors. See [AI Billing Guide: Scrubbing claims](/articles/AI-Billing-Guide-Scrubbing-claims). ## Verifying your work After working a denial, confirm: * The claim's status reflects the action (Resubmit, In Appeal, Settled, or Patient). * A **Claim Note** records what was done and the follow-up date. * The denial appears in [Denials Reporting](/articles/denials-reporting) so it counts toward your denial-rate KPIs. * Claim History shows the full audit trail. See [Claim History](/articles/claim-history). ## Related Articles * [Common Code Denials](/articles/common-code-denials) * [Claim Appeals](/articles/claim-appeals) * [Filing a Corrected Claim](/articles/filing-a-corrected-claim) * [Denials Reporting](/articles/denials-reporting) * [Posting a Payment in Elation Billing](/articles/posting-a-payment-in-elation-billing) * [Posting Voided, Reversed, or Updated Payments](/articles/posting-voided-reversed-or-updated-payments) * [Clearing Out a Payment](/articles/clearing-out-a-payment) * [Viewing ERAs and Auto-Posting](/articles/viewing-eras-and-auto-posting) * [Claim History](/articles/claim-history) * [Claims Queue](/articles/claims-queue) * [Manage patient credits and overpayments](/articles/how-can-i-manage-patient-credits-and-overpayments-in-elation-billing)